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中风-心脏综合征:当前的进展与未来展望。

Stroke-heart syndrome: current progress and future outlook.

机构信息

Department of Neurology, The People's Hospital of Suzhou New District, Suzhou, 215129, China.

Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China.

出版信息

J Neurol. 2024 Aug;271(8):4813-4825. doi: 10.1007/s00415-024-12480-4. Epub 2024 Jun 13.

Abstract

Stroke can lead to cardiac complications such as arrhythmia, myocardial injury, and cardiac dysfunction, collectively termed stroke-heart syndrome (SHS). These cardiac alterations typically peak within 72 h of stroke onset and can have long-term effects on cardiac function. Post-stroke cardiac complications seriously affect prognosis and are the second most frequent cause of death in patients with stroke. Although traditional vascular risk factors contribute to SHS, other potential mechanisms indirectly induced by stroke have also been recognized. Accumulating clinical and experimental evidence has emphasized the role of central autonomic network disorders and inflammation as key pathophysiological mechanisms of SHS. Therefore, an assessment of post-stroke cardiac dysautonomia is necessary. Currently, the development of treatment strategies for SHS is a vital but challenging task. Identifying potential key mediators and signaling pathways of SHS is essential for developing therapeutic targets. Therapies targeting pathophysiological mechanisms may be promising. Remote ischemic conditioning exerts protective effects through humoral, nerve, and immune-inflammatory regulatory mechanisms, potentially preventing the development of SHS. In the future, well-designed trials are required to verify its clinical efficacy. This comprehensive review provides valuable insights for future research.

摘要

中风可导致心律失常、心肌损伤和心功能障碍等心脏并发症,统称为中风-心脏综合征(SHS)。这些心脏改变通常在中风发作后 72 小时内达到峰值,并可能对心功能产生长期影响。中风后的心脏并发症严重影响预后,是中风患者死亡的第二大常见原因。尽管传统的血管危险因素与 SHS 有关,但中风间接引起的其他潜在机制也已被认识到。越来越多的临床和实验证据强调了中枢自主神经网络紊乱和炎症作为 SHS 的关键病理生理机制的作用。因此,评估中风后心脏自主神经功能障碍是必要的。目前,SHS 的治疗策略的发展是一项至关重要但具有挑战性的任务。确定 SHS 的潜在关键介质和信号通路对于开发治疗靶点至关重要。针对病理生理机制的治疗方法可能具有前景。远程缺血预处理通过体液、神经和免疫炎症调节机制发挥保护作用,可能防止 SHS 的发展。未来需要精心设计的试验来验证其临床疗效。本综述为未来的研究提供了有价值的见解。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d311/11319391/07326571c202/415_2024_12480_Fig1_HTML.jpg

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